Office Microlaparoscopy Using Augmented Local Anesthesia for Assessment of Primary Ovarian Insufficiency

Abstract

Objective: The objective of this study was to examine the usefulness of office microlaparoscopy with the patient under augmented local anesthesia in the assessment of types and future fertility prognosis of primary ovarian insufficiency (POI), after the failure to definitely visualize and measure both ovaries in women candidates included in the study. Methods: Forty-five patients with POI diagnosed in a private fertility care center between October 2006 and December 2010, who gave informed consent and underwent office microlaparoscopy under augmented local anesthesia, were studied. Pelvic ultrasound had failed to visualize and morphologically assess both ovaries in the women included. The cases were divided into four groups based on the microlaparoscopic ovarian morphology: group N (near to Normal), group G (gyrus shaped), group A (atrophied), and group S (streak shaped). These groups were analyzed with respect to patient background, blood hormone levels, and the level of antinuclear antibodies measured. Results: No significant differences in patient background and serum hormone levels were observed among groups. There was a complete absence of both ovaries in 5 patients included. There was a tendency toward increase in antinuclear antibody positive as the ovarian morphology approached normal, in contrast to both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) serum levels. Groups N and G showed some improvement, such as regular spontaneous menstruation, and forthcoming pregnancy, which happened in group N. Many other internal genital anomalies could be diagnosed during the same office micrlaparoscopic procedure. Conclusions: Office microlaparoscopy with the patient under local anesthesia is a useful procedure in the definite demarcation, and differentiation between the types POI, regarding menstrual regularity and future fertility prognosis. (J GYNECOL SURG 28:338)